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Ten tips on avoiding late running surgeries

Avoid delays for patients by making surgery sessions more efficient. By Professor Rodger Charlton

Running on time: there are methods of keeping to time that benefit not only the GP, but also the patient (Photograph: Getty Images)
Running on time: there are methods of keeping to time that benefit not only the GP, but also the patient (Photograph: Getty Images)

When I appraise colleagues, some say that one of their biggest weaknesses is their inability to run to time.

I try to be reassuring because good doctors give patients time and their problems are often complex and difficult to cover in 10 minutes.

However, patients do not like being kept waiting, so here are some tips to speed you up while retaining the high quality of care you provide.

TIP 1: Start early, not late

If a train starts off late, it is likely to arrive late. Hopefully your first booked patient will be early; if not, your second booked patient may have arrived. See them straight away to have a chance of running to time.

Then, perhaps, you will start the next patient's appointment two minutes early and will be able to free up extra minutes for a patient who takes longer.

TIP 2: Take extra slots to catch up

If your surgery regularly runs half an hour late, why not build in a 10-minute gap every few consultations? You will still see the same number of patients as colleagues and you will finish later, but you will feel less stressed and many of your patients will be seen on time.

TIP 3: Patients to return for time-consuming procedures

It may be that your patient needs, for example, a non-urgent blood test, vaccination or an ECG. There is no-one else available to do it, so why not ask them to come back later when you are less busy, explaining why and so allowing yourself to run to time?

TIP 4: Telephone calls

GPs have various arrangements about taking telephone calls during surgeries. Ideally, only take essential and emergency calls. A telephone consultation may last 10 minutes and then you are 10 minutes behind.

This sometimes involves a difficult decision, but a receptionist can note the patient's number for you to call back or give the patient a more convenient time to speak to you.

Telephone calls: ideally, only take essential and emergency calls during surgeries

TIP 5: Urgent referrals

No matter how quickly you can see patients, there is one consultation that will slow you down: the patient who requires hospital admission.

You must make a telephone call and the on-call doctor or bed bureau may be slow in answering. A referral letter will be required. You become stressed as you watch the clock.

Many admissions, other than chest pain, do not require immediate admission.

If the patient is a young child with a fever, the parent needs to go home to get night clothes. Asking them to come back at the end of surgery to collect a letter may be best for all concerned and will enable you to run to time and make any phone calls at the end of surgery.

TIP 6: Repeat prescriptions

These are non-urgent but it can be frustrating when a patient asks for repeat prescriptions at the end of a 10-minute consultation. Politely ask if the patient can make their request at reception or via the normal processes you have at your practice.

TIP 7: Uncertainty

A problem area is seeing new patients with undifferentiated illness and not being sure what is going on with them.

A classic example is a feverish child. You may want to check the symptoms in more detail and perhaps avoid a hospital admission.

If in doubt, see the patient again at the end of surgery. This will reassure you and the patient, and prevent overrunning.

TIP 8: Forms and correspondence

Letters, insurance forms and other computer input can wait until the end of surgery. So often, a patient thrusts a form in front of you asking for a signature, saying: 'It will only take a minute.' If only.

Politely decline, but give the patient a time when the paperwork will be ready to collect. If there is a private fee, tell the patient how much it is.

TIP 9: House visit requests

If you leave a booked surgery to do a house visit, it must be urgent. In cases of an MI or cerebrovascular accident, it may be appropriate to call an ambulance. Triage the call to ensure you make the right decision.

TIP 10: Teaching

Approximately 20% of GPs are involved in teaching and as more teaching moves into primary care, it will inevitably impact on the number and length of consultations a GP can undertake in a session.

If you are a GP teacher, particularly with undergraduates, plan surgeries carefully with your receptionists, practice manager and the other GPs so that the resultant extra appointments are allocated. As well as observing your surgery sessions, students can also help time-wise by assisting with complex patient record entries and referral letters after surgery has finished.

  • Professor Charlton is a GP and a professor of medical education at Swansea University

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Reflect on your last surgery that ran late and note if any of the tips here might be helpful or if you have any of your own.
  • Conduct a brief audit to find out how many patients were seen on time and, if not, what the average time delay was.
  • If you often run late, discuss a plan with your practice manager and colleagues about building in extra catch-up slots.

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